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Long-term results following extensive small intestinal resection in the neonatal period
Insights
Children surviving neonatal long-segment intestinal resection can achieve normal growth and absorption. Optimal postoperative care is crucial for long-term outcomes, even with less than 30 cm of remaining small intestine.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Neonatal long-segment intestinal resection (LSIR) presents significant challenges.
- Survival rates for LSIR have improved, necessitating understanding of long-term outcomes.
Purpose of the Study:
- To evaluate the long-term prognosis of children who underwent LSIR in the neonatal period.
- To identify factors influencing outcomes in survivors of extensive small bowel resection.
Main Methods:
- Retrospective case series of 9 children with extensive small bowel resection.
- Follow-up data, including clinical assessment and growth, were analyzed.
Main Results:
- Eight children from Alder Hey Children's Hospital and one from Zürich Children's Hospital survived LSIR.
- Children with 26-75 cm residual small intestine showed excellent long-term prognosis with proper postoperative care.
- Even with <30 cm of small intestine, adequate management led to normal growth and minimal absorption issues.
- A critical residual length of approximately 20 cm was noted.
- One case with suboptimal initial treatment experienced persistent difficulties.
Conclusions:
- Long-term survival and normal development are achievable for children after neonatal LSIR.
- Meticulous and prolonged postoperative care is paramount for successful outcomes.
- Early and appropriate management is critical, especially for cases with very short residual intestinal length.
Abstract:
At Alder Hey Children's Hospital in Liverpool there have been 8 children who survived long-segment intestinal resection in the neonatal period for more than 10 years, and there has been one further case at the University Children's Hospital in Zürich. The total of 9 children who were left with residual lengths of small intestine of between 26 and 75 cm form the basis of this report. Seven of these children have been personally followed up. One patient, although apparently perfectly well, is now an adult, has left home and refused to be re-examined. One child has been followed up by another paediatrician. In general it can be said that, provided these children are treated with care postoperatively over a period which may extend for many months or even a few years, the ultimate prognosis is extremely good. These children will grow up perfectly normally and will have no absorption difficulties. If the child is left with less than 30 cm of small intestine, the initial treatment becomes very difficult, but with adequate management even these infants can finally grow up into perfectly normal children with little or no absorption difficulties. The critical length of intestine lies in the neighbourhood of 20 cm. Correct initial treatment is all important and the one case in this series where this was not carried out is the only child who has still considerable difficulties. In some of the children under discussion, a hemicolectomy was performed as well as the small intestinal resection. This does not seem to have made much difference to the ultimate satisfactory outcome.